Han J G, Zhou J P, Wang G Y, Zhang H, Yang Y C, Lu Y, Wu B, Wu A W, Yao H W, Wang Z J
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of General Surgery, the First Hospital of China Medical University, Shenyang 110001, China.
Zhonghua Wai Ke Za Zhi. 2020 Aug 1;58(8):608-613. doi: 10.3760/cma.j.cn112139-20200421-00315.
To compare the wound healing time, Surgical site infection (SSI) rate and other postoperative outcomes between the gunsight closure and purse-string closure technique in loop stoma closure. Between November 2013 and December 2017, a total of 143 patients who underwent gunsight stoma reversal were included in this multicenter prospective randomized controlled trial. The patients were randomized to undergo gunsight (gunsight group, 72) or purse-string closure technique (purse-string group, 71). The primary endpoint was wound healing time. The second endpoints were the incidence of SSI, morbidity, and patient satisfaction. Statistical analysis between groups was performed using the -test, repeated measures analysis of variance, Mann-Whitney test, χ(2) test or Fisher's exact test. There were 45 males and 27 females with age of 67 (11) (M()) years in gunsight group, 42 males and 29 females with age of 65 (20) years in purse-string group. The body mass index, American Society of Anesthesiologist classification, comorbidities, primary diagnosis, the type of ostomy, intraoperative blood loss, perioperative complications, postoperative hospital stay, hospitalization cost, SSI rate and incisional hernia (stoma site) between the 2 groups were not significantly different (0.05). Although had a statistically longer operating time (80(10) minutes . 70(10) minutes, -2.381, 0.017), patients who underwent gunsight procedure and a significantly shorter wound healing time (17(2) days . 25(4) days, -10.199, 0.01), higher patient satisfaction score with regards to wound healing time (3(1) . 3(1), -4.526, 0.01), and higher total patient satisfaction score (25(3) . 25(3), -2.529, 0.011) compared with those who underwent purse-string procedure. The gunsight and purse-string techniques are effective procedures for stoma reversal and both have low SSI rate. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction compared with purse-string technique, and is recommended as the closure technique of choice.
为比较枪式闭合与荷包缝合技术在回肠造口关闭术中的伤口愈合时间、手术部位感染（SSI）率及其他术后结局。2013年11月至2017年12月，本多中心前瞻性随机对照试验共纳入143例行枪式造口回纳术的患者。患者被随机分为接受枪式闭合（枪式组，72例）或荷包缝合技术（荷包组，71例）。主要终点为伤口愈合时间。次要终点为SSI发生率、发病率和患者满意度。组间统计分析采用t检验、重复测量方差分析、Mann-Whitney检验、χ²检验或Fisher精确检验。枪式组有45例男性和27例女性，年龄为67（11）（M（））岁，荷包组有42例男性和29例女性，年龄为65（20）岁。两组间的体重指数、美国麻醉医师协会分级、合并症、主要诊断、造口类型、术中失血、围手术期并发症、术后住院时间、住院费用、SSI率和切口疝（造口部位）无显著差异（P>0.05）。虽然枪式手术的手术时间在统计学上更长（80（10）分钟对70（10）分钟，t=-2.381，P=0.017），但与接受荷包缝合手术的患者相比，接受枪式手术的患者伤口愈合时间显著缩短（17（2）天对25（4）天，t=-10.199，P=0.01），对伤口愈合时间的患者满意度评分更高（3（1）对3（1），t=-4.526，P=0.01），患者总满意度评分更高（25（3）对25（3），t=-2.529，P=0.011）。枪式和荷包技术都是有效的造口回纳手术方法，且SSI率均较低。与荷包技术相比，枪式技术的伤口愈合时间更短，患者满意度更高，建议作为首选的关闭技术。
